Creating Days that Have
Meaning and Joy
Teepa Snow, MS, OTR/L, FAOTA
Beliefs
• People with Dementia are Doing the BEST they
can
• We must learn to DANCE with our partner
• We are a KEY to make life WORTH living
• What we choose to do MATTERS
• We can change the WORLD with help
• We must be willing to CHANGE ourselves
• We must be willing to STOP & BACK OFF
How Can We Become Better Care
Partners?
Be willing to try something new
Be willing to learn something different
Be willing to see it through another’s eyes
Be willing to fail & try again
Ten Early Warning Signs
• memory loss for recent or new
information – repeats self
frequently
• difficulty doing familiar, but
difficult tasks – managing
money, medications, driving
• problems with word finding,
mis-naming, or misunderstanding
• getting confused about time or
place - getting lost while
driving, missing several
appointments
• worsening judgment – not
thinking thing through like
before
• difficulty problem solving or
reasoning
• misplacing things – putting
them in ‘odd places’
• changes in mood or behavior
• changes in typical personality
• loss of initiation – withdraws
from normal patterns of
activities and interests
The Basics for Success…
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Be a Detective NOT a Judge
Look, Listen, Offer, Think…
Use Your Approach as a Screening Tool
Always use this sequence for CUES
– Visual - Show
– Verbal - Tell
– Physical – Touch
• Match your help to remaining abilities
Now for Progression…
think GEMS not just loss
Sapphires
Diamonds
Emeralds
Ambers
Rubies
Pearls
Now for the GEMS…
Sapphires – True Blue – Slower BUT Fine
Diamonds – Repeats & Routines, Cutting
Emeralds – Going – Time Travel – Where?
Ambers – In the moment - Sensations
Rubies – Stop & Go – No Fine Control
Pearls – Hidden in a Shell - Immobile
What Do People with Dementia Need?
• DAILY Routine!!!!
• Help to Fill Their DAY with meaning
• A Balance of:
– Productive activity – feeling valued
– Leisure activity – having fun
– Self-care activity – wellness, health, personal care
– Restorative activity – sleep, rest, and re-energizing
• A Match-Up for Preferences:
– Large Group, Small Group, 1:1, Alone
– Active versus passive
– Sensory options – visual, auditory, tactile, olfactory, gustatory
What Are We Offering People?
• List Your Current Activities
– Monday-Sunday
• For Each Listing:
– What type of activity is it? P, L, S, R
– Is it working well?
– When Do You NOT Have something happening?
– What is MISSING?
What Does It Take
To Make a
Day Have Meaning and Joy?
Resources to
succeed
Manage the
ENVIRONMENT!
Know each
PERSON!
Understand
ACTIVITIES!
Build staff
SKILLS!
Make & Use a
SCHEDULE!
Know each Person
Life History
Who the person has
been…
Personal history and
background
Emotional status
psychological
condition and mental
health & limitations
Sensory Status
sight, hearing, touch,
balance, coordination,
temperature regulation
Health Status
medical conditions,
medications,
limitations & abilities
Cognitive Status
thinking, memory,
processing skills and
limitations
Routines and Habits
patterns of behavior,
daily routines, time use
& schedules
Personal Preferences & Values
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Who have you been?
What did you value?
Who are you now?
What do you value now?
Why does it matter?
Who gets a ‘say’?
Who gets to set the priorities?
Personality Traits
Who are you?
• Introvert-Extrovert
• Lots of Details – Big Picture only
• Logical – Emotional
• Planning ahead – Being in the moment
Who is the person you are trying to help?
Introvert - Extrovert
Introvert
• Likes to be alone
• Likes to think it out
• Likes personal space
• Needs alone time
• Private
Extrovert
• Think out loud
• Talk it out
• Seek out people
• Share a lot
• Not good with
boundaries
Life Story
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Family – past & present
Living place(s)
Work history
Leisure History
Music history
People history
Plant history
Animal history
Plant history
• Sensory Environment
preferences
• Cultural history & concerns
• Food likes & dislikes
• Daily routines
• Organizations &
memberships
• Roles & responsibilities
• Comforts & Irritants
Design Each Day
Offer a variety
of activities
every day
Make a
schedule and
follow it
Leisure, work,
rest, self-care,
groups and 1:1,
passive and
active
Be structured
BUT allow
flexibility
Create Group
schedules
BUT
also build
individual
schedules
Not everything
is for everybody!
8 am – coffee circle
8:30 – songs of joy
9 am – time to ‘go’
9:15 – take a hike – walk’n’roll
10 am – cool down & stretch
10:30 – watering hole
11 am - ‘use your brains’ games
11:30 - time to ‘go’ – wash up
11:45 – ‘set-‘em up’ crew
12 noon – let’s eat
12:30 – clean up crew
1 pm – music and meditation
1:30 – coupons clipping
2 pm – time to ‘go’
2:15 – let’s dance
Create a FLOW
for the day
Build up and
then slow down
Circadian
rhythms
Build a Foundation
of Familiar and Favorite
Activities
Add a few
special events and something
different
Understand Activities
What type of activity is it???
Self-care, leisure, work, rest…
Spiritual, social, physical, cognitive,
passive, active, solitary
Analyze the
Activity…
What is the
activity all
about?
What do you
need to do
it?
What skills,
abilities,
interests?
Doing
something
or
making
something?
Modify and Structure the Activity for
Success
Change the materials, the complexity, the
setting, the help offered, the task demands, or
the purpose of the activity
Two Examples
Paying Bills
• Do it independently
• Together – use a calculator
• Together – do all of them
• Together – do one at a time
• You do most, they sign and
put in envelopes
• You do all but the signature
• They put on stamps
• Both take them to the mail
box
Washing dishes
• Do it independently only
after meals
• Do it independently – when
needed to fill time
• Together – one wash one
dry
• Do parts
• Watch & guide
• Carry dishes to/from sink
Build Care Partner Skills
Group Leading
Skills
Getting people
together &
having fun
1:1 Interaction
Skills
Do you work
with your
partner(s)…
Practical
Hands-on
Skills
Crafts, games,
cooking,
working…
Planning & Time
Management
Skills
What to do &
when to do it!
Environmental
Management skills
Using space &
keeping up the
place
Peer
Relationship
Skills
Helping each
other
Observation
skills
What you see,
hear, sense…
Customer
Relations Skills
With families,
clients,
volunteers
Documentation
Skills
Record
keeping and
reporting
Problem-solving
skills
Figuring out what to
do when it does not
work right
Learn How to…
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Do something new…
Learn a new type of exercise or activity
Simplify a dance…
Re-look at a old skill and make it easier
Share a tasks
Do something without touching things
Get someone to do something without words
Give POSITIVE feedback and say “thanks”
Manage the Environment
Pay attention
to the lights,
sounds, seating,
work surface,
space…
Do the ‘right stuff’ in
the ‘right place’
Match what you do
to where you are…
Make set-up &
clean-up part
of the activity
Change it
around – if
you need to
- to make it
work!
Use the space
well
Plan and place
for BEST effect
Keep it ADULT
Give out tools and
materials ‘just in time’
Control the activity so
clients are successful –
not overwhelmed
- not out of synch
Create & Use
Storage
Make it look friendly
Get me to want to come
Make sure supplies,
activities, and games are
meaningful
Play & laugh with folks,
not at them
Take a look, listen, feel…
• Lighting- Enough, non-glare, focused
• Sounds – background, distracting, volume
• Feel –
– Temperature
– Space – how crowded – intimate, personal, public
– Work surface
– Seating surface
– Walking surface
– Familiar? Friendly? Fun? Forgiving?
Enough Supplies
& Materials
Good quality
lighting
Good work
surfaces
Enough help for
each person
The right
equipment for
clients’ needs
Skilled
leadership for
the activity
Seating that
works
A BACK-UP
Plan
Two Options…
DOING
• Filling socks – rice socks,
bean socks, corn socks…
• Adding herbs – lavender,
citrus, eucalyptus, mint
• Putting a sock inside
another sock
• Heating the socks
• Rubbing the socks over
muscles
• Emptying socks out
MAKING
• Fruit salad – from fresh fruit
• Fruit salad - from canned fruit
• Fruit salad – from pre-cut fruit
• Fruit salad – one fruit and
yogurt
• Fruit salad – dried fruit &
granola & yogurt
• Putting the fruit salad in small
cups or bowls
• Serving the fruit salad
How Do We Create Meaningful
Activities?
How to spend the time…
Key Activities to Consider
• Productive -Work
• Enjoyment - Leisure
• Wellness – Personal Care
• Restorative - Rest
Productive Activities
• Helping another resident
• Helping staff members
• Completing community
tasks
• Making something
• Sorting things
• Fixing things
• Building things
• Creating something
• Caring for things
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Counting things
Folding things
Marking things
Cleaning things
Taking things apart
Moving things
Cooking/baking
Setting up/breaking down
Other ideas….
Please Help Us Clean Up…
Leisure Activities
Active
Passive
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Socials
Sports
Games
Dancing
Singing
Visiting
Hobbies
Doing, Talking, Looking
Entertainers
Sport Program/event
Presenters
Lobby sitting
TV programs – watched
Activity watchers
Being done to
Playmate
Hey, hey, hey playmate
Come out and play with me
And bring your dollies three
Climb up my apple tree
Call down my rain barrel
Slide down my cellar door
And we’ll be jolly friends forever more.
Self-Care & Wellness Activities
Cognitive
Physical
• Table top tasks
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– Matching, sorting, organizing,
playing
• Table top games
– Cards, board games, puzzles…
• Group games
– Categories, crosswords, word
play, old memories
Exercise
Walking
Strengthening tasks
Coordination tasks
Balance tasks
Flexibility tasks
Aerobic tasks
Personal care tasks
BREATHE!!!
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Take a deep breath in
BLOW it all the way out
Take another breath in
BLOW it out
Take one final breath in AND
SING IT OUT….
• Feel what happened to you…
• Look at what happened to the people around you…
• Think about how and when you might do this…
Rest & Restorative Activities
• Sleep – Naps
• Listen to quiet music with
lights dimmed
• Look at the newspaper
• Look at a calm video on TV
screen
• Rock in a chair
• Swing in a porch swing
• Walk outside
• Listen to reading from a
book of faith
• Listen to poetry or stories
• Listen to or attend a
worship service
• Stroke a pet or animal
• Stroke fabric
• Get a hand or shoulder
massage
• Get a foot soak & rub
• Listen to wind chimes
• Aroma therapy
Offer a Shoulder Rub
& a Hand Massage
GOOD Activities
ones that involve…
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Plants
Animals
People
Music
Objects
How Does Skill Change Over Time
With Dementia?
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Interests
Helper cues that help
Environmental cues that help
Ability to focus & change focus
Sensory awareness & processing
Motor skills – gross and fine
Decision making & reasoning
Let Go:
• How it “used to be”
• How it “should be”
• How you “should be”
Identify
• What you’re good at…and what you’re not
• Who can help…and how they can help
• What really matters
Care Partners…
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Be a partner, not a boss
Be an advocate, build a team
Do with me, not for me or to me…
Learn the ‘SO WHAT?’ philosophy…
Learn to let go not give up
Learn what you are good at, & what not…
These ideas are for you TOO!
Final Note…
• Evaluate…
• How is it going…?
– What’s working?
– What’s not working?
• Is it time to change?
– Dementia is progressive
– Activities will need to change
• Its about letting go NOT giving up…
I Will Change!
(to the tune of
This Little Light of Mine)
By Teepa Snow
I am gonna meet and greet
Before I start to treat
I am gonna meet and greet
Before I check your feet
I am gonna meet and greet
Before I help you eat
How I start sets us up to succeed!
No more just “Getting’ it Done”
I’m gonna DO with you
No more just “Getting’ it Done”
I’m gonna help you thru
No more just “Getting’ it Done”
We’re gonna work, we two
Cause if I do it ALL, we BOTH LOSE!
I’m gonna laugh and dance with you
Not just watch and frown
I’m gonna laugh and dance with you
Not just stand around
I’m gonna laugh and dance with you
We’ll really go to town
For the POWER of JOY I have found!
Contact INFO
• DVD sets for $38.75
• www.pinesofsarasota.org
Web site – www.teepasnow.com
Home Instead Website: www.homeinstead.com